The safety and quality of acute patient care is strongly impacted by all levels of organizational leadership, yet few evidence-based methods for developing the knowledge and skills necessary for effective safety leadership currently exist. Simulation clearly improves technical and non-technical competencies of healthcare workers, as well as organizational learning and continuous improvement. However, simulation has not yet been broadly applied to the development of leadership for patient safety. This proposal assembles a multi-disciplinary team with unique and diverse expertise (simulation, training, gaming, engineering, patient safety leadership, business and management, social science of creativity, human factors and organizational psychology), and capitalizes on existing projects (an ongoing executive safety leadership collaborative with hospitals across the country) and strong relationships with state, national, and international healthcare organizations (for the purposes of recruitment) to design, implement, and evaluate organizational simulation for patient safety leadership development. In addition to demonstrating and disseminating organizational simulation as a tool to efficiently develop the technical and transformational leadership skills underlying effective safety leadership, this research advances the science regarding how best to use organizational simulation as a method for developing mid-level and executive safety leadership. Specifically, this project addresses two broad questions. First, is simulation more effective than traditional methods of instruction for improving patient safety leadership competencies? While simulation is generally superior to traditional methods for complex tasks, no comparative studies exist for executive and mi-level leaders in healthcare. Second, what makes simulation most effective and efficient as a training strategy and as a strategy generation tool for patient safety leadership? Two practically relevant approaches are investigated: the configuration of the teams participating in the simulation (intact vs. ad hoc), and a pre-training mindfulness intervention designed to boost learning and performance. Pre-training interventions are a proven way to maximize the efficiency of time spent in learning activities. Mindfulness is a promising cost-effective pre-training strategy that has not yet been evaluated. Given the lack of existing approaches to target healthcare leadership and the proven benefits of simulation in other domains, this research can make strong contributions to the science and practice of patient safety improvement. This project is innovative in that organizational simulation is a novel approach for developing safety leadership, and the online distributed method of delivering simulation to this audience has not been studied; our use of novel assessment approaches including situational judgment tests (SJTs) and coding of leadership behaviors; our application of the social science of creativity to provide valid assessments of problem solving performance, including organizational strategy development; the use of mindfulness training to improve the effectiveness of simulation; and, the diversity of expertise combined in this project team is unique.